HPV: The Health Crisis We’re Not Talking About

A recent and unscientific polling of some LGBTs about human papillomavirus (HPV) ventured some guesses: “Isn’t that the name of the warts people get on their junk?”; “That’s what women get that causes cervical cancer.”; “Doesn’t it give lesbians throat cancer?” 

The depth of our common knowledge about HPV isn’t substantial, which is to say it’s kind of like everyone else’s understanding of it. But certain factors in LGBT populations increase our risk of some serious health outcomes, including cancer. 

“Pretty much everyone is infected with HPV at some point in their life,” says physician Judith Shlay, interim director of Denver Public Health and director of immunization at the health department’s travel clinic. “It’s been around a long, long time.”

The virus is spread through vaginal, oral, and anal sex. The issue with HPV is that it often hides; not everyone infected will exhibit genital warts. And condoms — the prophylactic mainstay in the prevention of so many other STIs, including HIV/AIDS — don’t completely protect against the virus, as HPV resides on the skin on and around the carrier’s head, mouth, throat, vulva, cervix, vagina, penis, and anus. 

There are more than 100 strains of HPV, and most are — relatively speaking — harmless. In the majority of infections, the immune system takes care of HPV on its own. But roughly 40 strains may cause genital warts, and strains number 6 and number 11 have a 90% chance of causing an unsightly outbreak down below. 

“High-risk types of HPV can cause pre-cancerous changes not only on the cervix — which is what’s most commonly considered with HPV —  but also on the penis, in the anus, and in the throat,” Shlay says.

HPV strains 16 and 18 are the particularly nasty ones most linked to cervical and anal cancer, while 31 and 33 have been associated with cancer of the throat and penis. The LGBT community is about 44% more likely than straight adults to smoke cigarettes, and those infected run 2.5 times the risk of getting oral cancer as nonsmokers who are infected; heavy drinkers with HPV are three times as likely to develop oral cancer as non-drinkers with HPV.

Cancer Network estimates that 93% of HIV-positive gay and bisexual men have anal HPV infections, compared with 50% or less of heterosexual men. Because of the increased suppression of the immune system due to HIV/AIDS, the likelihood of anal and genital warts that are frequent, aggressive, and of abnormal composition needs to be minded. Regular screenings are recommended for those who are affected by both viruses. 

Currently, there’s no cure, which is why Shlay stresses urgency in getting vaccinated. “People in the U.S. have done well with cervical prevention because we have a pap smear test — it picks up anything abnormal, then we address it before it progresses,” she says. Additionally, abnormalities of the penis are more noticeable, “but with the throat or anus, you can’t always see them. We try to vaccinate younger people before they become sexually active — only the vaccine can prevent you from getting [HPV].” 

Abstinence is recommended, but for most, that’s a no-go. Condoms can assist somewhat, but again, there’s no guarantee. Sex toys can be infected by either you or your last partner, so they must be properly cleaned or even replaced after use with each partner. 

Shlay wants parents and young adults to shirk the notion that protection against HPV is a “girl’s vaccine.” “By reducing the burden of the virus in girls, you reduce the burden of the virus in boys,” she adds. Those between the ages of 11 and 26 have two options for a vaccine: Gardasil (for both males and females) and Cervarix (for cisgender females and trans males). 

For cisgender women and trans men, regular pap tests are your best bet for awareness of what’s going on inside you. There are anal pap smear cancer-screening tests for men who have sex with men, but often they must be requested, as physicians don’t use them routinely.